APPLICATION

About You

The information you provide in this section will be used to perform your background clearances which are required to serve in Kids Cove at CEFC.

Full Name
*

First Name Middle Name Last Name Suffix

Maiden Name

Last Name on Birth Certificate

Other Last Names/Aliases

Date of Birth
*

/
Month
/
Day Year

Date

Place of Birth
*

City

State / Province

Postal / Zip Code

Country

Gender
*

Male Female

Marital Status
*

Single Married Divorced Widowed

Are you 18 or older?
*

Yes No

Phone Number
*

-
Area Code Phone Number

Email
*

example@example.com

Current Address
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Social Security Number
*

Have you lived in PA consistently and entirely for the past 10 years?
*

Yes No

Previous Address
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

If you haven't lived in PA consecutively for the past 10 years, PA law requires us to ask you to be fingerprinted. In order for CEFC to register and pay for the fingerprinting service, we must schedule a time for the fingerprint service. Please indicate below which is the best place and time for you, and we'll let you know if we have made arrangements for you to be fingerprinted.

158 W High St, Carlisle

Mon / 1-4p Tue / 1-4p Wed / 10a-8p Thu / 10a-7p Fri / 10a-7p

6483 Carlisle Pike, Mechanicsburg

Mon / 9a-5p Tue / 9a-5p Wed / 9a-3:30p Thu / 9a-5p Fri / 9a-3:30p

Race
*

Asian African American Caucasian/Latino Native American

Ethnicity
*

Non-Hispanic Hispanic Unknown

Eye Color
*

Hair Color
*

Height
*

Feet and Inches

Weight
*

Pounds

Upload a copy of your Driver's License
*

Browse Files

Cancel
of

Serving in Kids Cove

Why would you like to serve in Kids Cove?
*

1st Choice - Where would you like to serve?
*

2nd Choice - Where would you like to serve?

3rd Choice - Where would you like to serve?

During which hour do you prefer to serve?

9:00 AM 10:45 AM 12:30 PM 4:30 PM

Do you prefer to be behind the scenes or in front of people?

Behind the scenes In front of people

Do you consider yourself to be more people-oriented or task-oriented?

People-oriented Task -oriented

Your Story

How long have you attended CEFC?
*

During which hour do you typically attend worship?

9:00 AM 10:45 AM 12:30 PM 4:30 PM

Tell us about any current and/or past experiences serving in ministry?

Briefly share when and how you accepted Christ as your Lord and Savior
*

How does your relationship with Christ impact your life today?
*

Ministry References

Non-Family References Only

Name
*

First Name Last Name

Relationship
*

Years Known
*

Phone Number
*

-
Area Code Phone Number

Email

example@example.com

Name
*

First Name Last Name

Relationship
*

Years Known
*

Phone Number
*

-
Area Code Phone Number

Email

example@example.com

Name
*

First Name Last Name

Relationship
*

Years Known
*

Phone Number
*

-
Area Code Phone Number

Email

example@example.com

By electronically submitting this form, I affirm that I am the individual listed under "full name" on this form and that the information provided is true to the best of my knowledge. It also affirms that the background certifications are necessary to satisfy the child protection laws and requirements, I have not received a background certification free of charge within the previous 57 months, and I understand that the certifications shall not be valid or used for any other purpose than volunteering or working with minors at CEFC. I also affirm that if I stated that I have not lived in PA consistently and entirely for the past 10 years that I am not disqualified from service pursuant to PA Title 23 subsection 6344(c). Should I commit an act against the law within the next 5 years, I will inform CEFC immediately.